极外侧型腰椎间盘突出症的诊断与治疗

DIAGNOSIS AND TREATMENT OF FAR-LATERAL LUMBAR DISC HERNIATION

目的 探讨极外侧型腰椎间盘突出症的诊断与治疗方法。方法回顾分析1999年1月～2004年1月收治16例极外侧型腰椎间盘突出症患者资料。其中椎间孔型8例，椎间孔外型2例，椎间孔内外混合型6例。L2.3 1例，L3,4 5例，L4,5例，L5、S1 2例。CT扫描显示在相应椎间孔内、椎间孔外、椎间孔内外有与椎间盘相同的CT值密度影像。手术采用椎板间入路10例，椎板侧方入路3例，椎板间和椎板侧方联合入路3例。结果术后16例均获随访6个月～5年，平均9个月。根据中华骨科学会脊柱组腰背痛手术评定标准：优8例，良5例，可3例。术后CT显示相应节段椎间盘突向椎间孔或椎间孔外的占位消失，同节段神经根压迫解除。结论CT是目前诊断腰椎间盘突出症的较好方法。手术入路应依突出椎间盘组织占位、病理类型及是否合并椎管内病变而定。

Objective To investigate diagnosis and treatment of far-lateral lumbar disc herniations. Methods The clinical data from 16 patients with far-lateral lumbar disc herniations from January 1999 to January 2004 were retrospectively analyzed. The CT scanning showed that the shadow density of the CT scanning values in the corresponding intra-foramen, extra-foramen and all foramen was as the same as that of the intervertebral disc. Of the 16 patients, 10 were operated on by the interlaminar approach, 3 were operated on by the laterolaminar approach, 3 were operated on by the combined interlaminal and laterolaminal approach. Results According to the follow-up for 6 months to 5 years, excellent results were obtained in 8 patients, good results in 5, and fair results in 3. The postoperative CT examination showed that the space occupying in the foramen or extra-foramen of the corresponding segment vanished and the nerve root compression of the identical segment also vanished. Conclusion The lamellar high-resolution CT is a better way to diagnose lumbar disc herniation. The operative approach should be chosen according to the position of the intervertebral disc protrusion, pathologic type, and presence or absence of the lesions in the vertebral canal.